Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2026
Characteristics and clinical significance of myocardial work in cardiac light-chain amyloidosis: pressure-volume loop analysis based on cardiovascular magnetic resonance.
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Liang Shichu, Wan Ke, Deng Qiao, Guo Jiajun, Li Jialin, Bi Keying, Li Danni, Chen Jing, Sun Jiayu, Zhang Qing, Han Yuchi, Chen Yucheng
Аннотация
BACKGROUND: Left ventricular pressure-volume (PV) loop analysis via cardiovascular magnetic resonance (CMR) offers noninvasive assessment of cardiac thermodynamic efficiency. We aimed to evaluate the clinical relevance and prognostic value of noninvasive PV-loop parameters in patients with cardiac light-chain (AL) amyloidosis.
METHODS: This prospective, single-center study enrolled patients with cardiac AL amyloidosis (AL-CA) who underwent CMR between November 2011 and September 2023. PV-loop parameters were derived from CMR cine images and brachial blood pressure. The primary endpoint was all-cause mortality. Cox regression analysis assessed associations between PV-loop parameters and outcomes, with incremental prognostic value evaluated using C-statistics and likelihood ratio tests.
RESULTS: The single-center, prospective study included 267 consecutive AL-CA patients (mean age, 58.8 ± 9.8 years; male/female, 168/99) and 30 healthy controls with similar age and sex (mean age, 59.9 ± 8.2 years; male/female, 15/15). Work efficiency (WE) showed moderate to strong correlations with cardiac function, volumes, decreased activity, and amyloid burden (all P < 0.05). During a median follow-up of 42 months (interquartile range: 35-49), the all-cause mortality rate was 69.3% (185/267). Univariable Cox analysis showed AL-CA patients with WE <72.2% were at higher mortality risk (hazard ratio 2.45, 95% confidence interval: 1.68-3.57; P < 0.001). After multivariable adjustment, WE <72.2% remained an independent prognostic factor. The integration of WE with Mayo 2004 stage enhanced prognostic discrimination and calibration (C-statistic 0.65, χ² 36.28) relative to Mayo 2004 stage alone (C-statistic 0.58, χ² 25.79), and performed comparably to the combination of extracellular volume (ECV) fraction with Mayo 2004 stage (C-statistic 0.66, χ² 44.49).
CONCLUSION: Myocardial work impairment can be detected early, even with preserved left ventricular ejection fraction. WE derived from noninvasive and non-enhanced PV-loop analysis via CMR, not only reflects disease severity as quantified by ECV, but also serves as an alternative marker to ECV in risk stratification.
METHODS: This prospective, single-center study enrolled patients with cardiac AL amyloidosis (AL-CA) who underwent CMR between November 2011 and September 2023. PV-loop parameters were derived from CMR cine images and brachial blood pressure. The primary endpoint was all-cause mortality. Cox regression analysis assessed associations between PV-loop parameters and outcomes, with incremental prognostic value evaluated using C-statistics and likelihood ratio tests.
RESULTS: The single-center, prospective study included 267 consecutive AL-CA patients (mean age, 58.8 ± 9.8 years; male/female, 168/99) and 30 healthy controls with similar age and sex (mean age, 59.9 ± 8.2 years; male/female, 15/15). Work efficiency (WE) showed moderate to strong correlations with cardiac function, volumes, decreased activity, and amyloid burden (all P < 0.05). During a median follow-up of 42 months (interquartile range: 35-49), the all-cause mortality rate was 69.3% (185/267). Univariable Cox analysis showed AL-CA patients with WE <72.2% were at higher mortality risk (hazard ratio 2.45, 95% confidence interval: 1.68-3.57; P < 0.001). After multivariable adjustment, WE <72.2% remained an independent prognostic factor. The integration of WE with Mayo 2004 stage enhanced prognostic discrimination and calibration (C-statistic 0.65, χ² 36.28) relative to Mayo 2004 stage alone (C-statistic 0.58, χ² 25.79), and performed comparably to the combination of extracellular volume (ECV) fraction with Mayo 2004 stage (C-statistic 0.66, χ² 44.49).
CONCLUSION: Myocardial work impairment can be detected early, even with preserved left ventricular ejection fraction. WE derived from noninvasive and non-enhanced PV-loop analysis via CMR, not only reflects disease severity as quantified by ECV, but also serves as an alternative marker to ECV in risk stratification.